ascorbic acid + biotin + cocarboxylase tetrahydrate + 9 other active ingredients: clinical use

Prescribing considerations

• Include vitamins from nutrition, supplements and medicines when assessing total exposure.
• Specific deficiencies may require targeted replacement.
• Assess vitamin B12 status when deficiency is possible or prolonged supplementation is anticipated.
• Assess vitamin K separately.
• Confirm compatibility before addition to parenteral nutrition or Y-site administration.

Contraindications and cautions

• Hypersensitivity to an active ingredient or excipient, particularly thiamine.
• Soy or peanut protein or product allergy.
• Hypervitaminosis involving any included vitamin.
• Use additional caution in hepatic or renal impairment because susceptibility to toxicity may be increased.

Monitoring

• Clinical response and relevant vitamin concentrations during prolonged use or when this is the sole vitamin source.
• Liver function and signs of hepatobiliary disease.
• Vitamin A exposure, especially with hepatic disease, severe renal impairment or multiple vitamin sources.
• Vitamin B1 in dialysis and vitamin B6 in renal impairment where clinically indicated.
• Potential biotin or ascorbic-acid interference with laboratory results.
• Infusion-site and systemic hypersensitivity reactions.

Clinical pharmacology

A parenteral combination of water-soluble and fat-soluble vitamins, excluding vitamin K. Components act as enzyme cofactors or support antioxidant defence, cell differentiation, haematopoiesis, connective-tissue metabolism and calcium homeostasis.

Formulation and product differences

• Sterile orange-yellow lyophilised powder requiring reconstitution before intravenous administration.
• Contains 12 vitamins but no vitamin K.
• Contains soy-derived phosphatides and sodium.
• Light, oxygen, bisulfites, alkaline conditions or high calcium concentrations may reduce vitamin stability; compatibility must be established.